Strategy to curb HIV/AIDS prevalence in southern regions
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WAR on HIV/ AIDS: A sign showing that ‘one cares.’

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THE Walter Reed Program Tanzania (WRP-T)/ Henry M Jackson Foundation Medical Research International (HJFMRI) is a comprehensive HIV/AIDS research and prevention program based in the southern highlands regions of the country.

Over the years, the program has also grown to include the President’s Malaria Initiative (PMI), enhancing malaria diagnostics capabilities and expertise. Since 1999, MHRP has worked with local collaborators to advance research on effective HIV vaccine and promote HIV prevention.

Research is conducted in partnership with the National Institute of Medical Research, the University of Munich (LMU), the Mbeya Regional Medical Office, and the Mbeya Referral Hospital.

Together, these collaborating institutions form the Mbeya Medical Research Center (MMRC). HJFMRI or locally known as “Walter Reed ProgramTanzania” is a United States of America federally funded program which supports PEPFAR activities in the Republic of Tanzania.

The HJFMRI program, in collaboration with the MoHCDGEC and community NGOs, has been leading a comprehensive HIV and AIDS care and support program in the Southern Highlands of Tanzania since 2004.

The program, which is sub-contracting with Regional Health Management Teams (RHMTs) and 14 community outreach partners, extends to 25 district councils in Mbeya, Songwe, Rukwa, Katavi and Ruvuma Regions.

Collectively, this zone, which has one of the highest HIV prevalence rates in Tanzania, represents a catchment area with close to six million people equivalent to 13 per cent of the population of Tanzania mainland.

Despite remarkable achievements made over the past 10 years, the expansion of HIV care and treatment interventions still remains critical both at the facility as well as the community level.

The latest statistics show that the rate of HIV/ AIDS infections inRukwa Region has spiraled, jumping from 4.9 per cent in 2009 rate to 6.2 today.

The chilling information was revealed by the Acting Rukwa Regional Medical Officer, (RMO), Dr Emanuel Mtika that the situation is worrisome as the figures are big, a situation that calls for increased efforts in solving the problem.

According to the latest statistics, the situation in the region is worse in Sumbawanga municipality whose prevalent rate stands at 6.5per cent. Prevalence in Nkasi District stands at 3.1 per cent.

This is an indication that the prevalence is worsening in the region. “Even though the national HIV/ Aids prevalence rate has dropped to 5.7 per cent, in reality the situation is worsening in Rukwa Region standing at 6.2 per cent, up from 4.9 per cent in 2009/10,” says the acting RMO.

Similar sentiment is echoed by the Rukwa Regional Commissioner (RC) Mr Zelothe Steven who says “The situation is worse and needs to be seriously addressed. “Actually this scary development should prompt the regional health sector to focus on increasing efforts in educating the public on preventive measures.

I’m told despite the male circumcision campaign yet the figures are still high, ” recounts the RC. Recently, the Walter Reed Programme, Tanzania chapter, operating within the southern highlands zones has set up a gadget for routine viral load testing at three regional facilities, in Mbeya and Ruvuma, but the third waits fitting at the Rukwa Regional Referral Hospital.

All have come at a total cost of over 4bn/-. The WRP-T has also donated a new brand Land Cruiser tuck valued over150 /- to Sumbawanga District Council in Rukwa region which will play a leading role in the fight against HIV and AIDs in the precinct.

VIRAL load is the term used to describe the amount of HIV in your blood; viral load tests measure the amount of HIV’s genetic material in a blood sample. A viral load test measures the number of HIV viral particles permillilitre of blood.

A low viral load indicates that treatment is effective. A high viral load in a person on treatment indicates either that the medication is not being taken properly or that the virus is becoming resistant to the medication.

Dr Joseph Chintowa, WRPT’s senior technical director, explains further that the programme in Tanzania also administers allied initiatives in the regions of Mbeya, Rukwa, Ruvuma and Katavi.

He says that at a ceremony to hand over a Land Cruiser truck valued over 150m/- to the Sumbawanga District council Strategy to curb HIV/AIDS prevalence in southern regions WAR on HIV/ AIDS: A sign showing that ‘one cares.’ of Rukwa region at a short celebration held here recently.

“Routine viral load tests improve treatment quality and individual health outcomes for people living with HIV… it also contributes to prevention, and potentially reduces resource needs for costly second and third-line HIV medicines,” says Dr Chintowa.

“ For a decade now WRPT, in collaboration with the Ministry of Health and Social Welfare, has been leading a comprehensive HIV and AIDS care and support programme in the southern highlands of Tanzania … it caters for more than 750 health facilities,” he added.

In 2004, a US military HIV research programme (MHRP) began work on HIV prevention, care and treatment services, funded by the President’s Emergency Plan for AIDS Relief (PEPFAR) under the country’s department of state and the Office of Global AIDS Coordinator.

Dr Chintowa also revealed that the vehicle was bought with funds from the US President President’s Emergency Plan for AIDS Relief (PEPFAR). He named Mbeya Re gional Hospital, Mbeya Regional Referral Hospital and Ruvuma Regional Referral Hospital in Songea Town as key centres where the testing apparatus had since been set up.

“Viral load testing and CD4 counts play a key role in the diagnosis of opportunistic infections and managing some aspects of treatment; but people living with HIV – and currently on anti retroviral therapy with routine viral load monitoring -- have better health outcomes than people monitored with CD4 testing alone,” he added.

Further, he revealed that the viral load testing apparatus for Rukwa Regional Referral Hospital had since been acquired, but that it’s installation still awaits expansion works on a special room that will house the facility.

On the vehicle, he said it would play a leading role in the fight against HIV and AIDs and urged the people to turn out for voluntary testing.

He also said the WRP-T project has since set up solar power panels at Dr Atman Hospital here within the municipality as well as at health centres at Muze and Ilemba within the Lake Rukwa basin in Sumbawanga District--each at the cost of over 50m/-.

Rukwa Regional Medical Officer, Dr Boniface Kasululu lauded the WRP move, saying it was timely as reassuring, pledging it would be put to good use. Sumbawanga District council Chairman, Mr Kalolo Ntila has meanwhile directed the acting district executive director, Mr Deogratius Kangu to ensure that the council honours such donation by using them to serve the people.

For people living with HIV who are stable on antiretroviral therapy, World Health Organization (WHO ) no longer recommends routine CD4 monitoring, for several reasons: it is a variable and unstable measure that does not determine care outcomes; it is not applicable to infants or breastfed children; and CD4 counts typically remain stable in people.

“Viral load tests prevent patients being unnecessarily switched to more expensive medicines or left to continue on ineffective therapy that can lead to drug resistance and ultimately death.” Médecins Sans Frontières physician undetectable viral loads.

Some resource-limited countries have drastically reduced CD4 monitoring in favour of increased viral load testing.

For example, South Africa discontinued routine CD4 monitoring for people living with HIV who achieve viral suppression, a shift that is expected to save US$ 68 million between 2013 and 2017.

Cameroon, Kenya, Malawi, Namibia, Swaziland, Thailand and Uganda alsono longer recommend routine CD4 testing, unless viral load testing is unavailable.

Using viral load testing for early infant diagnosis Even though prevention of mother-to-child transmission services have averted 1.2 million HIV infections among infants since the mid-1990s, 220 000 children acquired HIV in 2014.

Because HIV-related infant mortality peaks at two to three months of age, early diagnosis and immediate treatment are imperative to prevent illness and death. For infants born to mothers living with HIV, WHO currently recommends early infant diagnosis with a viral load test four to six weeks after birth.

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